Friday, December 5, 2008

Open Letter to Dr. Frederick Goodwin

Dear Dr. Goodwin,

Thank you for taking the time to respond to my blog postings regarding this unfortunate disclosure controversy.

I’ll start by apologizing for the single false statement I made: “the segment itself was partially funded by Pfizer, maker of Zoloft.” I got that wrong. Pfizer did not fund that particular segment, but it has, indeed, been one of the underwriters of The Infinite Mind. According to the producer's website, many other drug companies have funded the program, including Eli Lilly, Abbott Laboratories, Scios, Searle, Janssen, and Solvay. According to an email from Bill Lichtenstein, the last drug company grant the show received was in 2005.

However, I stand by all my other statements. Regardless of who actually invited the guests, chose the topic, or suggested questions, you were ultimately responsible for what was said. You were there behind the microphone, asking questions, making comments, and steering the discussion.

While you appear to blame Mr. Lichtenstein for the show’s failings, saying that he put it together “in a hurry,” in fact Mr. Lichtenstein tells me that he did not produce this segment at all, and had hired a freelance producer to coordinate it.

You also blame Mr. Lichtenstein for the fact that Peter Pitt’s PR work for drug companies was not disclosed. However, you are on the board of directors of Center for Medicine in the Public Interest (CMPI), a pro-industry front group which receives a majority of its income from drug companies. Peter Pitts happens to be the president and co-founder of this same organization. How could you have not known of his financial relationships with the pharmaceutical industry? And assuming you did know, how could you have not made certain that this was disclosed to listeners?

You state that I am “damaging the reputation of distinguished academic scholars such as a professor at UCLA.” I assume you are referring to Andrew Leuchter, a professor of psychiatry at UCLA who was one of the guests on the Prozac Nation: Revisited show. In fact, I said nothing to damage his reputation. Dr. Leuchter is a brilliant researcher who I once interviewed for an articleon the uses of EEG in psychiatric practice. He takes money from pharmaceutical companies for research on antidepressants, which he discloses on his website. There’s nothing wrong with that. But this information should have been disclosed to listeners—not to discredit him, but to alert listeners that these financial relationships might (or might not) have influenced his opinions about the dangers of antidepressants.

To conclude, I’m hoping that you and your supporters, such as John McManamy, will stop blaming everybody else for this mess. Don’t blame the New York Times—they were merely reporting the facts. Don’t blame scientologists—they haven’t even participated in this discussion. Don’t blame Bill Lichtenstein, Gardiner Harris, Charles Grassley, Slate Magazine, Shannon Brownlee, Jeanne Lenzer, or even Daniel Carlat.

This entire fiasco could have been averted if you had chosen to inform NPR listeners of your financial conflicts of interests at the beginning of shows focusing on pharmaceuticals.

13 comments:

Anonymous
said...

Psychiatry seems to be in the habit of blaming eveyone else--they blame family physicians and non-psychiatrists for the fact that people with depression do not get better instead of admitting the drugs are not as efficacious and effective as advertised; they blame patients' being overweight and obese for their poor lifestyle when many drugs cause weight gain, especially atypical antipsychotic drugs, but also antidepressant drugs, lithium and some antiepileptic drugs; they blame anyone who disagrees with them for being "Scientologists". They blame us for being non-compliant as if it were unusual for people with chronic conditions to have problems being in treatment and taking drugs over long-periods of time. They refuse to admit facts about adverse effects of drugs, effectively nullifying informed decision making. They profess not to understand that payments by the drug industry compromise their scientific objectivity, and that they are supposed to obey the regulations of their employer and NIH wrt payments received.

Okay, this will probably be dismissed as specious....but how about this as turnabout in the Fair Play Department?

Every time a psychiatrist/psychologist is interviewed by the media, writes a book, or hosts a TV/radio show, that psychiatrist/psychologist has to disclose his non-pharma biases. For example:

1. "I have been anti-medication ever since childhood, when I was forced by my abusive parents to take medication for my alleged bi-polar disorder. These unimaginative people simply would not accept that, in fact, I AM God. Fortunately, my patients do recognize my omnipotence -- because I've made sure of it. The fact that they don't get better? Don't split hairs with me! That's treatment resistance!"

2. "I flunked science class from high school on and wouldn't know a neuron from a moron. Big Pharma wants to reduce us all to a science experiment! Feelings -- that's what's important."

3. "I fell under the sway of a highly charismatic guru in grad school, and, being insecure and rather weak intellectually, I swallowed everything she/he said hook, line, and anti-medication sinker. But when I cite his philosophy, I feel more powerful."

4. "I have bills to pay, dammit, and patients aren't wanting to pay for my services once they experience benefits from psychopharmacology. Moreover, I am not willing to adapt to the times and learn new information in order to help those patients."

5. "I am contrarian by nature, meaning that I have limited ability to understand complex subjects and, moreover, I like to stand out from the pack. So, if the 'smart money' embraces pharmacology, I'll oppose it! Would you like to quote me on that? Make sure you spell my name right."

I appreciate your points, Daniel, but maybe you and others should consider pulling back on your lens just a tiny bit.

"This entire fiasco could have been averted if you had chosen to inform NPR listeners of your financial conflicts of interests at the beginning of shows focusing on pharmaceuticals."

------This is how such a statement would be heard in the public's mind:

"Oh, this person has no legitimate knowledge in this area. He is being paid by Big Pharma and therefore, he must be bad bad bad. Why else would they make him say that?"

Daniel, why don't you just tell every clinician and researcher who has stepped into the 21st Century (and has the intellectual/educational chops to do so) to be branded with a giant P on their foreheads. That should take care of it!

I just have to say I find the extremism that pervades this medium to be pathetic and a waste of time to those who are sincerely looking for answers to legitimate and painful problems.

Yes, there is a sizeable percentage of psychiatrists, like the ones mentioned at this site, and others, who succumb to greed and power, just like in any other field in our culture. And yet, those who want to hide behind anonymous screens and gross exaggerations, just want to bash an entire group of people because of the incredibly poor judgment of what in the end is a minority, maybe not 5%, but certainly not 95% either. So yes, clinicians like me, who are outraged by these colleagues who dampen our efforts to help people, have to be further outraged by extremists who believe in pitchforks and torches.

It is like politics these days, you have to listen to pathetic rhetoric of conservatives and liberals, when about 50% of this country is moderate and negotiable.

I don't know about anyone else who reads these blogs, but if extremism and sensationalism is what is sought, I get the sense this medium is living on borrowed time. Does anyone care about the pursuit of health and common sense?

The suicide rate had been dropping until the officious intermeddlers started in. Now, it is jumping up. All officious intermeddlers should be physically forced to attend family survivor meetings of the Suicide Prevention Foundation. Let them hear the stories of lawyer and left wing wacko ideologue interference with the desperate attempts of families to get their loved ones into treatment until the point of death.

The left wing extremist gotcha peddler, a running dog of insurance companies, has blood on its hands. All officious intermeddlers should be sued. To deter.

By his articles, Dr. Goodwin has likely saved the lives of 1000's or more patients. By his unwarranted, witch hunt, bad faith attacks on paper work shuffling trivial infractions, the left wing ideologue wacko kills 1000's of people a year.

I can find these gotchas in the records of every left wing wacko ideologue in a minute, no exceptions. That includes insurance running dog, Grassley.

TF - I guess my previous compliment of you from someone you brand as an extremist doesn't fall in the gray area. Interesting how you didn't respond to that but when I post something you deem as extreme, you show no hesitation in labeling me one of those dreaded extremists/anti psychiatry flamers.

Just you know I am consistent on this, I complained bitterly to the owner of an alternative health website when I felt he posted a study that was deceptive. He never mentioned that the product used was sold by one of the contributors to the study.

Gina has a noteworthy point in stating that "But 'out there,' it's anti-meds and anti-psychiatry."

In a world where there exists museums dedicated to the "evils of psychiatry," (Sunset Blvd., Los Angeles), where religious cults preach anti-meds and anti-psychiatry, and where a legislative bias toward psychiatric patients continues to breed, one should not confuse the ethical debate about marketing drugs with the obvious contributions made to biological psychiatry by the pharmaceutical industry. By dismissing the enormous advances in psychopharmacology -- noted eloquently by Gina in a recent ADHD medication posting -- as a bogus pharma plot, we flirt with encouraging the perception that psychiatry is not a legit branch of medicine. To my knowledge, there is not a museum dedicated to the "evils of oncology."

If you call it tremendous progress that people on neuroleptics are dying 25 years earlier than most people and that there is brain shrinkage according to Nancy Andreson (sp?) who is not an evil scientologist, I don't know what to say frankly. Actually, I am speechless.

Even people who defend psychiatry know enough to say, that is the best we have for now.

And if there is as much progress as you claim there is, can you point me to a link of a long term study on this like 5 years? If you do, I would appreciate one that is free so I can see exactly what you are evaluating.

But back to the topic. Again, smoke screen issues are being used to divert from what the main issue is.

If I, AA, extolled the virtues of a supplement on a radio show and you found out later that I was paid by the company, you would not be happy and rightfully so. You would be smacking alternative folks as lacking ethics. But yet, for some reason, when psychiatry does something similar, it is defensible.

By the way, I do not work for any alternative health companies as I was just using a hypothetical situation to make a point.

I am not sure how to best respond to AA's comments other than to point out that many of us know people who have been treated successfully with psychotropics for more than five years. As to ongoing psychiatric clinical trials, I believe that most of the large NIMH-sponsored trials are at five years or better. True -- we don't have the town of Framingham to follow over decades like the cardio guys do -- but long-term efficacy data has been well established among numerous psychotropic classes.

I am not aware of any conclusive data which shows, as you claim, that "people on neuroleptics are dying 25 years earlier than most people." This claim supposes that psychotropic medications have a higher mortality rate than cigarette smoking. That would certainly be front page news if there was an echo of truth in it.

Finally, Supremacy Claus speaks volumes in pointing out that suicide rates have inexplicably risen at the same time in which physicians have been scared to prescribe antidepressants by Black Box Warnings and the like. The logical inter-relatedness in that is damn scary.

As to Dr. Goodwin's financial remuneration for his NPR program, that has been pretty well beaten to death, so I don't know what more I can add, other than the obvious bottom line: The ombudsmen of medical ethics out there must find a way to allow physician thouthleaders to lecture amongst colleagues (or the public for that matter) and to be compensated fairly for their time.

I was mistaken. Neuroleptics weren't blamed directly and they aren't the whole story but they certainly are a strong suspect as evidenced in this report:

http://psychrights.org/articles/2006NASMHPDonEarlyDeath.pdf

Even if you feel the evidence is weak in this report, you can't blow off brain shrinkage, which was reported by Nancy Andreason. Interesting how you avoided responding to that.

It is also interesting that you can't give me a direct link of a study that shows efficacy.

Not that smoking is wonderful but if someone held a gun to my head and forced me to pick between cigarettes and antipsychotics, I would pick the cigarettes. I would die early but at least, I wouldn't have the mindless lifeless blank stare that people on neuroleptics have.

Regarding antidepressants and blackbox warnings, several articles came out after the last controversy showing that the studies were flawed. Clinical Psych on his website said the following:

"It is important to note that the authors of the paper did not have data from 2005, but there is nothing from the 2003-2004 U.S. SSRI prescription data cited in their paper that even suggests a relationship between decreased SSRI use in youth and an increased suicide rate, as the decrease in prescriptions was minimal. Pay close attention: The authors ran a total of zero statistical analyses to examine the relationship between SSRI prescription rates and suicide rates in the United States. That’s right, zero. So they put up a couple of figures without a single shred of statistical evidence, then claim that declining SSRI prescriptions are associated with an increase in suicide rates. Any peer reviewer who was not drunk or on a high dose of Seroquel should have noticed this gigantic flaw."

http://tinyurl.com/8sqouc

SC, anyone who flames Dr. Carlat is usually not worth responding to. But I will make this one comment to give inspiration to people who wonder if they can live a med free life. I have been able to taper off of my psych meds in spite of dealing with my mother's death, employment instability, and severe insomnia as a withdrawal symptom.

Tapering slowly is the key as most psychiatrists taper way too quickly and then falsely claim that withdrawal symptoms are a return of the illness. Joseph Glenmullen, who is not antimeds, mentions this in his book, the Antidepressant Withdrawal Solution.

I would say more but I sense you're not really not interested in hearing our stories and will just spin it for your pro med purposes. Also, I have already gotten too off topic.

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About Dr. Carlat

I am a psychiatrist in Newburyport, Massachusetts and an Associate Clinical Professor of Psychiatry at Tufts Medical School (but note that the opinions expressed in this blog are not those of Tufts). I graduated from the psychiatric residency at Massachusetts General Hospital in 1995, and am the founder and publisher of three CME newsletters, including The Carlat Psychiatry Report. In March 2012, I left the publishing world to work on conflict of interest issues for The Pew Charitable Trusts, as director of the Pew Prescription Project. I returned to Newburyport and Carlat Publishing in September 2014.